Abstract
BackgroundDespite significant investments and reforms, health care remains poor for many in Africa. To design an intervention to improve access and quality of health care at health facilities in eastern Uganda, we aimed to understand local priorities for qualities in health care, and factors that enable or prevent these qualities from being enacted.MethodsIn 2009 to 2010, we carried out 69 in-depth interviews and 6 focus group discussions with 65 health workers at 17 health facilities, and 10 focus group discussions with 113 community members in Tororo District, Uganda.ResultsHealth-care workers and seekers valued technical, interpersonal and resource qualities in their aspirations for health care. However, such qualities were frequently not enacted, and our analysis suggests that meeting aspirations required social and financial resources to negotiate various power structures.ConclusionsWe argue that achieving aspirations for qualities valued in health care will require a genuine reorientation of focus by health workers and their managers toward patients, through renewed respect and support for these providers as professionals.
Highlights
Despite significant investments and reforms, health care remains poor for many in Africa
In order to build on existing literature, which is extensive in describing priorities in health care qualities, we provide only a short summary of the qualities valued by participants and focus on the latter issues of the enactment of care
We found that valued qualities in health care went beyond absolute resources and skills, to positive interpersonal interactions, and that the enactment of these valued qualities was contingent on navigation of power relationships by different actors including health care seekers, health workers and district officials
Summary
Despite significant investments and reforms, health care remains poor for many in Africa. In spite of significant global investment, the majority of developing countries are not on target to achieve Millennium Development Goals 4 and 5, to reduce the under-5 mortality rate by two-thirds and the maternal mortality ratio by three-quarters between 1990 and 2015 [1]. Failure to reach these targets has been blamed on ‘health system bottlenecks’ that prevent the ability to scale up coverage of key interventions [1,2]. Investment in human or equipment resources in efforts to strengthen health systems have had limited effect in the absence of efforts to improve health-service management and coordination [2]
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